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See a sample rate comparisonCPT 81465 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Whole Mitochondrial Genome, Whole Mitochondrial Genome Large Deletion Analysis Panel Eg Kearns Sayre Syndrome Chronic Progressive External Ophthalmoplegia Including Heteroplasmy Detection If Performed
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Genomic Sequencing Procedures and Other Molecular Multianalyte Assays |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | XS - Separate Structure 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $936.00 national lab fee schedule rate (2026) · View Medicare rates for 81465 |
| Medicaid Fee Schedule | $936.00 median of the 8 states in the free preview · View Medicaid rates for 81465 |
National average reimbursement for CPT 81465 by major payers:
$731.28
$573.28
$920.31
$1,315.16
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CPT 81465
5 of 25 sample ratesHigher to lower in this preview
Vineetha Alias
Atlantic Health System Inc
$1,251.30Published rateAaron Askew
Praxis Health, P.C.
$1,029.60Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$690.23Published rateChristopher Raio
Mercy Medical Center
$505.44Published rateE And A Medical On The Go Healthcare Of South Florida LLC, E And A Healthcare On The Go
E And A Medical On The Go Healthcare Of South Florida LLC
$327.60Published rate
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See a sample payer proposalCPT 81465 vs. Other Genomic Sequencing Procedures and Other Molecular Multianalyte Assays Codes
The CPT 81465 code is part of the Pathology and Laboratory Procedures services used for Genomic Sequencing Procedures and Other Molecular Multianalyte Assays. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 81465 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 81437-CPT | Moderate | Pathology Panel/Obstetric, Hereditary Neuroendocrine Tumor-Related Disorders (Eg Medullary Thyroid Carcinoma Parathyroid Carcinoma Malignant Pheochromocytoma Or Paraganglioma) Genomic Sequence Analysis Panel 5 Or More Genes Interrogation For Sequence Variants And Copy Number Variants; Genomic Sequence Analysis Panel Must Include Sequencing Of At Least 6 Genes Including Max Sdhb Sdhc Sdhd Tmem127 And Vhl |
| 81439-CPT | Moderate | Hereditary Cardiomyopathy (Eg Hypertrophic Cardiomyopathy Dilated Cardiomyopathy Arrhythmogenic Right Ventricular Cardiomyopathy) Genomic Sequence Analysis Panel Must Include Sequencing Of At Least 5 Cardiomyopathy-Related Genes (Eg Dsg2 Mybpc3 Myh7 Pkp2 Ttn) (Desc Revised 1/1/2018) |
| 81460-CPT | Moderate | Whole Mitochondrial Genome, Whole Mitochondrial Genome Eg Leigh Syndrome Mitochondrial Encephalomyopathy Lactic Acidosis And Stroke Like Episodes Melas Myoclonic Epilepsy With Ragged Red Fibers Merff Neuropathy Ataxia And Retinitis Pigmentosa Narp Leber Hereditary Optic Neuropathy Lhon Genomic Sequence Must Include Sequence Analysis Of Entire Mitochondrial Genome With Heteroplasmy Detection |
| 81465-CPT | Moderate | Whole Mitochondrial Genome, Whole Mitochondrial Genome Large Deletion Analysis Panel Eg Kearns Sayre Syndrome Chronic Progressive External Ophthalmoplegia Including Heteroplasmy Detection If Performed |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81465. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81465 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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